1. Field of the Invention
This invention relates to a method and apparatus for providing permanent epicardial pacing comparable to permanent transvenous pacing in the acutely ill or debilitated patient under local anesthesia as well as for providing drainage of pericardial fluid and pericardial biopsy.
2. Description of the Prior Art
The medical treatment of symptomatic atrioventicular conduction defects is known to be fraught with difficulties and uncertainties. As a result, long-term electrical stimulation has gained wide acceptance. Three basic methods of myocardial stimulation have been used successfully: external stimulation through the chest wall, transvenous electrode catheter stimulation, and permanent myocardial electrode stimulation. Each method of electrical stimulation of the myocardium has been shown to suffer from some imperfection, either inherent in the method of stimulation or caused by the reaction of local tissue to the electrode.
Conventional techniques for pericardial biopsy and drainage of pericardial fluid include a left thoracotomy, and direct attack on the left side of the pericardium, through the thoracotomy incision, for conventional biopsy and drainage of the fluid; the left chest cavity then being drained via a chest tube. The second conventional approach is excision of the xiphoid process through a larger, midline incision and direct biopsy of the pericardium after grasping the pericardium with a surgical clamp. The pericardial cavity is then drained if necessary, with a tube introduced through this xiphoid incision.
The advantages of the present invention over currently available epicardial techniques are the avoidance of a thoracotomy incision, a chest tube and general anesthesia, or, if local anesthesia is used, avoidance of xyphoid process removal and its attendant postoperative pain. The advantages over transvenous pacing include reduction of early and late wound problems and marked reduction in early and late failure-to-capture problems.
The main advantage of pericardioscope biopsy and drainage is that a tiny surgical incision is made and minimal discomfort is experienced by the patient.